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MHS Rates : Pharmacy

Pharmacy Rates

Pharmacy rates are derived from the Managed Care Pricing File (MCPF) supplied by the Defense Supply Center - Philadelphia (DSCP) and are based on TRICARE allowable charges, Average Wholesale Price (AWP) or Prime Vendor Program (PVP) prices listed for the National Drug Codes (NDCs) in the MCPF. Rates are established on a unit measure price basis (e.g., cost per tablet) and are standardized for NDCs within each generic sequence number (GSN). A GSN groups a set of NDCs with the same active ingredient(s), dosage form and strength regardless of vendor brand name or generic designation. Prior to the August 2006 pharmacy table update, rates were computed for each GSN based on the lowest unit measure price for any NDC within that GSN. Currently rates are computed based on the median unit measure cost for all of the AWP listed NDCs in each GSN group. The median unit measure price is applied to all the NDCs in that GSN group. When there are no AWP listed NDCs in a GSN group, the rate for the NDCs in that group is set to the median unit measure price of the PVP listed NDCs in that GSN group. As of January 2010, unit measure prices will reflect the median TRICARE allowable ingredient costs.

Available pharmacy rate tables are listed below. Because of the size of these files, downloading may take a few minutes.

August Pharmacy Rate Files – Effective August 17, 2015

The DHA UBO Program Office released the August 2015 Pharmacy Rate File and August 2015 Formulary and Over-the-Counter (OTC) Unit Rates – Biller’s Edition, effective August 17, 2015. A sample notice to inform pay patients of updates to pharmacy prices and the availability of a pharmacy pricing estimator (PPE) to calculate charges for pharmaceuticals prior to purchasing them at a Military Treatment Facility (MTF) will be made available for individual MTFs to display this message. The DHA Prior Authorization list in the August Biller’s Edition Workbook will remain the same as the previous February 2015 version. For the most accurate information on whether a specific drug requires prior authorization please use the Formulary Search Tool . Prior to submitting claims to other health insurance (OHI) carriers, MTFs should also review the applicable insurance carrier’s website for information and its current list of its pharmaceuticals that require preauthorization.

  • August 2015 Pharmacy Rate File (effective 08-17-15)
    August 2015 Pharmacy Rate File (effective 08-17-15) xlsx 4191.4 KB
    (posted 08-17-15)
  • August 2015 Formulary and OTC Unit Rates - Biller's Edition (effective 08-17-15)
    August 2015 Formulary and OTC Unit Rates - Biller's Edition (effective 08-17-15) xlsx 13201.9 KB
    (posted 08-17-15)
  • February 2015 Pharmacy Rate File (effective 02-16-15)
    February 2015 Pharmacy Rate File (effective 02-16-15) xlsx 4053.4 KB
    (posted 02-09-15)
  • February 2015 Formulary and OTC Unit Rates - Biller's Edition REVISED (effective 02-16-15)
    February 2015 Formulary and OTC Unit Rates - Biller's Edition REVISED (effective 02-16-15) xlsx 13302.9 KB. The revised February 2015 Biller’s Edition supersedes the previously published version, which should now be deleted (8-13-15).

  • Pharmacy Rate Files (2012-2014)

  • August 2014 Pharmacy Rate File
    Pharmacy Rate File Effective 081914 xlsx 4065.2 KB
    (posted 08-11-14)
  • August 2014 Formulary and OTC Unit Rates - Biller's Edition
    August 2014 Formulary and OTC Unit Rates - Biller's Edition xlsx 14580.4 KB
    (posted 08-11-14)

  • February 2014 Pharmacy Rate File
    Pharmacy Rate File Effective 021714 xlsx 4067.8 KB
    (posted 02-18-2014)
  • February 2014 Formulary and OTC Unit Rates - Biller's Edition
    February 2014 Formulary and OTC Unit Rates - Biller's Edition xlsx 14633.3 KB
    (posted 02-18-2014)

  • August 2013 Pharmacy Rate File
    Pharmacy Rate File Effective 081913 xlsx 3899.4 KB
    (posted 08-13-2013)
  • August 2013 Formulary and OTC Unit Rates - Biller's Edition
    FY13 UBO OTC Pharmacy Rate Listing Effective 08/19/13 xlsx 15921.9 KB
    (posted 08-13-13)

  • February 2013 Pharmacy Rate File
    Pharmacy Rate File Effective 021613 xlsx 4143.4 KB
    (posted 02-13-2013)
  • February 2013 Formulary and OTC Unit Rates - Biller's Edition
    FY13 UBO Pharmacy Rate Listing Effective 021613 xlsx 13593.7 KB
    (posted 02-13-2013)

  • August 2012 Pharmacy Rate File
    Pharmacy Rate File Effective 080612 xlsx 4249.9 KB
    (posted 08-01-2012)
  • August 2012 OTC Unit Rates
    FY12 UBO OTC Pharmacy Rate Listing Effective 080612 xlsx 2735.1 KB
    (posted 08-01-2012)

  • February 2012 Pharmacy Rate File (posted 02-20-2012)
    Pharmacy Rate File Effective 02292012 xlsx 6367.3 KB
  • February 2012 OTC Unit Rates (posted 02-20-2012)
    FY12 UBO OTC Pharmacy Rate Listing Effective 02292012 xlsx 2805.6 KB

  • Historical pharmacy rate files can be found on the Archives page.

    Estimating Pharmaceuticals Costs

    The UBO has developed pricing estimators to assist pay-patients and other government organizations with estimating the costs of pharmaceuticals provided by DoD. The Pharmaceutical Price Estimators are available through the links below or from the UBO Helpdesk. Running the pharmacy estimator requires Microsoft Access version 2007 or newer. Links to recent versions of the estimators are provided below.

    Pharmaceutical Price Estimator - Effective 8-17-15 - Access 2007 Version zip 13711.3 KB
    (posted 8-17-15)

    Pharmaceutical Price Estimator - Effective 2-16-15 - Access 2007 Version zip 13556.4 KB
    (posted 2-9-15)

    Pharmaceutical Price Estimator - Effective 8-18-14 - Access 2007 zip 13274.1 KB
    (posted 8-11-14)

    Pharmaceutical Price Estimator - Effective 8-18-14 - Access 2007 zip 13274.1 KB
    (posted 8-11-14)

    Pharmaceutical Price Estimator - Effective 02-17-14 - Access 2003 zip 9293.9 KB
    (posted 02-18-2014)

    Pharmaceutical Price Estimator - Effective 2-17-14 - Access 2007 zip 13775.7 KB
    (posted 02-18-2014)

    Pharmaceutical Price Estimator - Effective 8-19-13 - Access 2003 zip 11716.7 KB
    (posted 08-13-2013)

    Pharmaceutical Price Estimator - Effective 8-19-13 - Access 2007 zip 14206.8 KB
    (posted 08-13-2013)

    DoD Pharmaceutical Price Estimator Effective 02-16-2013 Access 2003 zip 9254.6 KB
    (posted 02-13-2013)

    DoD Pharmaceutical Price Estimator Effective 02-16-2013 Access 2007 zip 13579.4 KB
    (posted 02-13-2013)

    DoD Pharmaceutical Price Estimator - Effective 8-6-2012 - Access 2003 zip 9335.0 KB
    (posted 08-01-2012)

    DoD Pharmaceutical Price Estimator - Effective 8-6-2012 - Access 2007 zip 14379.5 KB
    (posted 08-01-2012)

    DoD Pharmaceutical Price Estimator Effective 02-29-2012 Access 2003 zip 12749.4 KB
    (posted 02-20-2012)

    DoD Pharmaceutical Price Estimator Effective 02-29-2012 Access 2007 zip 13641.6 KB
    (posted 02-20-2012)



    Historical Pharmacy Price Estimators are available in the Archives page.




    Contact us:

    For questions or comments, please e-mail UBO.Helpdesk@altarum.org, or leave a message for the Helpdesk staff at 202-776-1532. Phone messages will be returned within one business day.

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